K990 – First Person Seen
OHIP Consultation & Visit Premium Codes Code — GENERAL PREAMBLE · Schedule of Benefits
A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service. The K990 premium is payable for the first patient seen at the destination (Emergency Department) when the visit is non-elective and the service commences on a weekday between 07:00 and 17:00. A travel premium (K960) must also be eligible for payment for this premium to apply during daytime hours. This premium is not eligible for payment to Emergency Department Physicians as defined on page .
When to Use
- Use K990 when you are a non-ED physician called to the Emergency Department for a non-elective, urgent assessment during weekday daytime hours (07:00-17:00).
- Apply this code when you travel from your office or another facility to the hospital specifically to see a patient in the ED, provided the visit is initiated by the patient or hospital staff.
Common Pitfalls
- Billing K990 as an Emergency Department physician is a common rejection; this code is strictly reserved for physicians who are not defined as ED staff under GP67.
- Failing to link K990 with the mandatory K960 travel premium during daytime hours will result in a claim rejection unless you are traveling within the same hospital complex.
- Attempting to bill K990 for elective consultations or follow-ups that were pre-scheduled will trigger an audit, as the service must be non-elective.
Billing Tips
- Always pair K990 with the appropriate A-prefix assessment code from the General Listings to ensure the base service is captured alongside the premium.
- If you see multiple patients during the same trip to the ED, use K990 for the first patient and the corresponding K991-K999 codes for subsequent patients to maximize your claim.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table I - Emergency Department)
The time at which the special visit takes place must be documented on the medical record.
Not eligible for payment to Emergency Department Physicians (see definition )
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